Harmony Haven Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:34 AM. LPA met with facility staff who contacted the facility Administrator Kajo Movsesian. The Administrator arrived to the facility at 09:40 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:45 AM the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer which contained knives and other sharp objects. LPA observed a fire extinguisher mounted on the wall that was last serviced on 04/08/2026. The kitchen contained a locked under sink cabinet which contained cleaning supplies and an additional locked cabinet which contained resident medications and facility files. BEDROOMS: There are four (4) bedrooms in the facility; two (2) are dual occupancy resident rooms and two (2) are single occupancy resident rooms. LPA and the facility Administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All four (4) bedrooms contained a direct exits to the outdoors of the facility. CONTINUED ON LIC 809C. BATHROOMS: There are two (2) bathrooms at the facility. Both are designated as a shared/common resident bathrooms. Both resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Both bathrooms contained locked under sink storage cabinets that contained resident grooming supplies. Grab bars were observed in all resident showers and near all resident toilets. All were properly secured. The water temperature was measured to be between 111.0 and 114.8 degrees Fahrenheit, which is within the range required by regulation. LPA observed an unsecured bottle of bleach spray in a shared bathroom. LPA notified the Administrator who immediately secured the item. COMMON AREAS: This included the living room and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a television and activities for resident use. Additionally, the living room contained an additional fire extinguisher that was last serviced on 04/08/2026. The dining area was observed to be equipped with adequate seating for resident use. LPA observed a closet to contain the facility’s washer and dryer. All furniture throughout the facility was observed to be clean and in good repair. The facility’s combination fire and carbon monoxide alarms were tested at 10:30 AM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. OUTDOOR SPACE: The facility has two (2) emergency exit gates located in the front yard of the facility; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed a secured storage shed that contained miscellaneous care supplies. LPA observed an unsecured bottle of floor cleaner in the backyard of the facility. LPA notified the Administrator who immediately secured the item. RECORD REVIEW: Record review began at 10:31 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Six (6) staff files were reviewed. All staff files contained all required documents and trainings. Five (5) resident files were reviewed. All resident files contained all required documentation and signatures. CONTINUED ON LIC 809C. RECORD REVIEW CONT: During record review LPA was notified that two (2) former residents of the facility had passed away on 09/01/2025 and 10/06/2025. LPA reviewed the incident reports that were submitted to Community Care Licensing Division (CCLD) and did not observe an incident report submitted for either death. LPA notified the Administrator that a written report shall be submitted to the licensing agency and to the person responsible for a resident within seven (7) days of the occurrence of the death of any resident from any cause regardless of where the death occurred. The Administrator expressed understanding and agreed to submit the reports to CCLD. MEDICATION REVIEW: Medication review began at 11:13 AM. Medications for three (3) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/20/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. One (1) resident interviewed stated that the staff treat them well and are attentive to their needs. One (1) resident interviewed had concerns with the facility. LPA interviewed two (2) staff members with the assistance of the Administrator acting as a translator. The staff members interviewed were knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, emergency disaster plan, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 17, 2026

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:35 AM. LPA met with facility staff who contacted the facility Administrator Kajo Movsesian. The Administrator arrived to the facility at 09:47 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:47 AM the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. LPA observed a fire extinguisher mounted on the wall to be serviced on 05/21/2025. The kitchen contained a locked cabinet containing cleaning supplies and an additional locked cabinet containing resident medications and facility files. Continued on LIC 809C. COMMON AREAS: This includes the living room and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains a television and activities for resident use. Additionally, the living room contained an additional fire extinguisher that was last serviced on 05/21/2025. The dining area was observed to be equipped with adequate seating for resident use. Additionally, the dining area contained storage closets which contained extra linens for resident use. LPA observed a closet to contain the facility’s washer and dryer. All furniture throughout the facility was observed to be clean and in good repair. The facility’s combination fire and carbon monoxide alarms were tested at 10:20 AM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. BEDROOMS: There are four (4) bedrooms in the facility; two (2) are dual occupancy resident rooms and two (2) are single occupancy resident rooms. LPA and the facility Administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All four (4) bedrooms contained a direct exit to the outdoors of the facility. BATHROOMS: There are two (2) bathrooms at the facility. Both are designated as a shared/common resident bathrooms. All resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Both bathrooms contained locked under sink storage cabinets that contained resident grooming supplies and laundry detergent. Grab bars were observed in all resident showers and near all resident toilets. One (1) grab bar was observed to be loosely secured to the wall in bathroom #2. The water temperature was measured to be between 120.6 and 121.5 degrees Fahrenheit, which is outside of the range required by regulation. OUTDOOR SPACE: The facility has two (2) emergency exit gates located in the front yard of the facility; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed a secured storage shed that contained miscellaneous care supplies. Continued on LIC 809C. RECORD REVIEW: Record review began at 10:21 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained all required documents and trainings. Five (5) resident files were reviewed. All resident files contained all required documentation and signatures. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 11:20 AM. Medications for three (3) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/16/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed three (3) residents. All residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. LPA interviewed one (1) staff member with the assistance of the Administrator acting as a translator. The staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 19, 2025

Allegation investigated: Staff are neglecting resident's care needs.

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 09:56 AM. LPA met with facility staff who contacted the facility Administrator Kajo Movsesian. The Administrator arrived to the facility at 10:20 AM the reason for the visit was explained and entrance interview was conducted. During today’s visit LPA conducted a physical plant tour, reviewed four (4) resident files, reviewed medications for three (3) residents, obtained copies of pertinent documentation, and interviewed the Administrator, one (1) staff and five (5) residents between 10:20 AM and 01:00 PM. Continued on LIC-9099C Unsubstantiated The allegation of “Staff are neglecting resident's care needs.” alleges that the facility is not providing adequate care for resident #1 (R1) by neglecting R1’s food needs, administering R1’s medications incorrectly, and not assisting R1 with mobility. LPA Byrne interviewed five (5) current facility residents. Four (4) of the five (5) residents interviewed had no concerns with the quality of care they were receiving at the facility. When interviewed R1 stated that the facility staff are nice and take care of everything for them. R1 stated that facility staff bring their medications at the same time every day and that they are receiving enough food. R1 stated that they do not get out of bed often as they don’t think it is a good idea due to the condition of their legs. R1 confirmed that facility staff check on them regularly and respond quickly to requests for assistance. R1 had no concerns with the quality of care they are receiving at the facility. LPA Byrne conducted a medication audit for R1 and two (2) additional residents. All medications were documented appropriately on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. LPA Byrne interviewed the facility Administrator. The Administrator stated that residents of the facility are fed three (3) meals a day with snacks in-between. The Administrator stated that the facility accommodates resident meal requests if they would like something other than what is being served. The Administrator stated that they encourage residents to be active and to move throughout the facility with staff assistance, but that staff will respect a resident’s decision to stay in bed if they choose. The Administrator stated that they are not aware of any medication issues with the residents and confirmed that medications are given as prescribed and on time each day. LPA interviewed staff #1 (S1) with the assistance of the Administrator acting as a translator. S1 is a caregiver at the facility and confirmed that they assist residents with everything including transferring from bed. S1 stated that there are three (3) residents, including R1, that generally prefer to stay in bed. S1 stated that residents are encouraged to be out of bed for mealtimes and for showers, but staff will always respect a resident’s wish to stay in bed. S1 confirmed that resident medications are given as prescribed and on time each day. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff are neglecting resident's care needs.” Therefore, the allegation is deemed Unsubstantiated at this time. No deficiencies were cited during today’s inspection. A copy of the report was printed and exit interview was conducted.the state’s words, verbatim · CDSS document, Apr 29, 2025 · control 29-AS-20250421133804

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Emily Peraldi conducted a pre-licensing visit to the above noted facility. At 12:47 p.m., the LPA met with applicant, Kajo Movsesian. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver for six (6) has been approved. At 12:56 p.m., a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility is one story. The facility has four (4) resident bedrooms. All bedrooms have a direct exit to the outside. Bedridden resident is allowed in resident bedroom #1. All resident rooms are set up with beds, nightstands, lamps, chairs, chest of drawers and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed). Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms – ‘awake night staff only’ - is required. All rooms were free of odors. All window screens were clean and maintained in good repair. There are two (2) bathrooms in the facility. The resident bathrooms have a shower with non-skid materials/ mats. The toilet and shower have grab bars. The hot water temperature was tested in the bathroom and the kitchen and was found to be within the range of 105*F and 120*F. Resident and staff records will be stored in a locked kitchen cabinet. Medications are centrally stored in locked kitchen cabinet. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. Continued on LIC 809-C. Kitchen knives are stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area. Appliances in the kitchen were clean and all appeared functional. Cleaning supplies were locked away under the kitchen sink. Laundry and house cleaning supplies are stored inside a locked bathroom cabinet. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment, games and/or activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included but not limited to flashlights. The facility had emergency food and water supplies. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. At 1:12 p.m., the smoke detector and carbon monoxide detectors were tested and functioned properly. The facility has a central entry point for symptom screening and temperature checks for staff and visitors. There are hand sanitizers available throughout the facility. The fire extinguishers were fully charged and serviced on 06/03/2024. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted throughout the facility. The emergency telephone numbers are posted near the entrance of the facility. Other required postings are also posted near the entrance of the facility. Continued on LIC 809-C. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. The property is gated. One side of the house is designated for an emergency exit. The lot in which the facility is located on has an accessory dwelling unit (ADU) on the side next to the facility and is not part of the license. The ADU will remain inaccessible to residents. There are no bodies of water on the premises at the present time. Component III was conducted in conjunction with this pre-licensing visit. No corrections required. Exit interview conducted. A copy of the report was issued. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.the state’s words, verbatim · CDSS document, Jun 5, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Kajo Movsesian Interview Method: Telephone interview On April 09, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 9, 2024